演題番号：3
テーマ 2：UHC（ユニバーサルヘルスカバレッジ）
The associasion between health insurance literacy and participation in supplementary healthinsurance among low- and middle-income working population in Shandong, China:
a cross-sectional study.
Ruosu Liu1, Ong Ken Ing Cherng1, Jing Wang2, Limei Feng2, Zhigang Gao3, Junko Kiriya1,
Masamine Jimba1, Akira Shibanuma1
1School of International Health, Graduate School of Medicine, The University of Tokyo, Japan
2

Chinese People's Liberation Army 80th Army Group Hospital, China
3

Weifang People’s Hospital, China【Background】 Out-of-pocket healthcare spending is likely to become a huge burden in many partsof the world. When general health insurance is insufficient, participating in supplementary healthinsurance could reduce a person’s financial burden. However, the mechanism of participation in
supplementary health insurance is not well studied. Among possible determinants of healthinsurance participation, health insurance literacy (HIL) has not been studied in China and manyother low- and middle-income countries. Therefore, to better understand participation in
supplementary health insurance, this research aimed to 1) examine the association between HIL
and participation in supplementary health insurance and 2) identify other factors associated withparticipation.
【Methods】 This is a cross-sectional study conducted in Shandong Province, China. The target
population in this study was workers. Workers who met the following criteria including 1) lived inShandong, China, 2) had basic health insurance, including employee health insurance and resident
health insurance, 3) had an annual household income of no more than 500,000 Chinese Yuan (74,600
USD), 4) had more than 12 years of education, 5) aged 19 and above were included. Those whowork in the insurance industry and those with supplementary health insurance purchased by theirworkplaces were excluded. A questionnaire with 39 questions consisting of Health Insurance
Literacy Measure and socio-demographic questions was used for data collection. Study participants
were recruited both online and in person. Data were analyzed using multivariable logistic regression.
【Results】 Among 391 workers, 87.4% had employee health insurance, and 12.6% had resident healthinsurance, while 39.1% participated in supplementary health insurance. Of all, 55.5% had a lower
HIL level. HIL was not associated with participation in supplementary health insurance (adjustedodds ratio [AOR] 0.99, 95% confidence interval (CI): 0.61, 1.61). Other factors associated withparticipation in supplementary health insurance were responsible for more family members (AOR
1.22, 95% CI: 1.05, 1.43) and having acquaintances who knew insurance well (AOR 1.74, 95% CI:1.00, 3.02).
【Conclusions】 In thvis study, higher HIL was not associated with participation in supplementary

health insurance. Workers who had more dependent family members and those who were close tosomeone who knows insurance well were more likely to participate in supplementary healthinsurance. Although about half of the workers had high HIL in this study, that might not lead toincreased participation in supplementary health insurance. The benefit of supplementary healthinsurance might be understood more among those in need due to having more dependent family
members and those who had chances to know it through personal connections. To promoteparticipation in supplementary health insurance, it is essential to offer reliable information,
particularly for those who did not perceive its immediate needs and benefits.